• Zika Update From Rubens Belfort


    Zika virus (ZIKV) is moving fast, with every state in the United States now reporting cases. At the Uveitis Subspecialty Day, Rubens Belfort Jr., MD, PhD, provided a succinct overview of this developing threat to public health.

    Acquired. In many cases, adults who have contracted ZIKV don’t even realize that they are affected. General symptoms include fever, rash, and joint pain; ocular symptoms include conjunctivitis, acute anterior uveitis, and retinal microangiopathy.

    Congenital. Of 150 newborns with microcephaly evaluated in Brazil, 34% have eye abnormalities, Dr. Belfort said. Of those, 70% are affected in both eyes. Findings include optic nerve abnormalities, chorioretinal atrophy, and focal pigment mottling, which tends to be more frequent at the posterior pole and varies in size and shape.

    • Atypical onset. The absence of microcephaly does not mean that an infant is out of the woods, Dr. Belfort noted, as some infants who don’t have the brain abnormality do have the ocular lesions. In addition, late onset has been noted, with infants who initially seemed to be healthy now showing ocular problems.
    • Differential diagnosis. Other congenitally acquired infectious diseases must be ruled out, including cytomegalovirus, HIV, rubella, syphilis, and toxoplasmosis, Dr. Belfort said. In addition, potential genetic causes should be investigated, and parental drug abuse (including alcohol) should be assessed.

    Prevention and diagnosis. Mosquito control is the only option with regard to prevention, as there is no treatment, and no vaccines are available, Dr. Belfort said. Pregnant women who live in known risk areas should be tested for ZIKV during the first trimester and have serial testing if the initial results are negative, he added. In the United States, the CDC provides updated recommendations regarding travel to affected areas.

    Other threats.
    Looking forward, Dr. Belfort warned that ZIKV is not the only mosquito-borne disease that poses a threat to public health. “Yellow fever is back. Malaria and dengue fever are problems.” And referring to a global map illustrating the spread of the chikungunya virus, he asked, “Is chikungunya next?”—Jean Shaw  

    Financial disclosures.
    Dr. Belfort: Abbvie: C,L,S; Alcon Laboratories, Inc.: C,L,S; Allergan, Inc.: C,L,S; Novartis Pharmaceuticals Corporation: S; Ophthalmos: S; Ophthotec: S; Roche: S; Santen, Inc.: S

    Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.

    More on Monday.
    Attend Zika Virus: What the Ophthalmologist Needs to Know (Sym61) .